Recruitment and Retention of Health Care Providers in Remote Rural areas



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Introduction


This report provides baseline information about the NHS Highland area. It forms the basis for comparisons in the area of recruitment and retention of Healthcare providers. The report includes general information about the NHS Highland area including; geography and demography, the organisation of the health services and staff. The figures in this report are based on the NHS Highland boundary which includes both the Highland and Argyll and Bute Local Authority areas.
  1. Geography


NHS Highland covers an area comprising the largest and most sparsely populated part of the UK and represents more than 40% of the land mass of Scotland. From the Southern to the Northern tip is more than 300 miles. Much of the landscape is mountainous, interspersed with sea lochs along the coast and fresh water lochs inland. The west coast of the region is long in comparison to the regions size, with many inlets and islands.

The Highlands have a temperate climate, warmed by the ‘North Atlantic Drift’, with higher temperatures than other countries on similar latitude. Average temperatures vary with the affects of proximity to the coast and topography, but average annual temperature at low altitude is 7-8°C, with a lowest recorded temperature of -27°C in Altnahara and a highest recorded of 32.1°C in Onich. The mountainous scenery of the Western Highlands results in high rainfall with Fort William averaging 4000mm of rain per year. However, in the east of the region, near the Moray Firth, rain fall is considerably lower, averaging 700mm/year. Snowfall is usually confined to the months November to April, but with snow cover rarely prolonging at low altitude. Upland areas, however, may retain snow cover for around 7 months of the year1.

The Highlands are reached via road and rail from the other regions in Scotland and via air from across the UK and Europe. The region is served from the South and East by trunk roads, carrying significant road traffic particularly in the summer months, but many parts of Highland are linked by a series of single track roads mainly in the West of the region. Bad weather in the winter can result in road, rail and air disruptions and closures.

Seventy five percent of the Highland population live in areas classified as remote or rural compared to twenty percent in Scotland as a whole2. The Highland region has a population density at 9 persons per km2 fallen to only 2 persons per km2. The Scottish average is 67 persons per km2.3 These remoteness and sparsity factors, in addition to the regions geography and transport infrastructure place obvious challenges in delivering health services particularly where the focus of government policy is to provide care as near to the patient as possible. This remoteness has also contributed to the difficulties in attracting healthcare professionals to work in these areas. The implications of such factors for the population’s health are felt in terms of accessibility of services and also in other direct impacts on a person’s health arising from the economic vulnerability and social isolation of their remote-rural situation.



These challenges are felt much less in the regions urban areas. The region’s capital, the city of Inverness, has a population of around 60000 and is one of Europe’s fastest growing cities. The city is a thriving place to live and work and is considered to have a high quality of lifestyle. The city accommodates the District General Hospital, the Executive Office for Scotland’s newest university; the University of the Highlands and Islands and is the main transport hub for locations across the region and to the Islands. However, Inverness, too, can suffer from a perception of remoteness from the other main urban areas in Scotland, which in itself can impact the attraction of students and professionals to the city.



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